MTB Infectious Disease

Question 1

What is the treatment for MRSA

Answer 1

Vancomycin
Linezolid
Daptomycin

Question 2

What is the treatment for cellulits

Answer 2

minor dz: dicloxacillin or cephalexin
Pen allergic: macrolides or clindamycin

Severe dz: Oxacillin, nafcillin, cefazolin
Pen allergic: Vancomycin or Daptomycin

Question 3

What is the treatment for gonorhea or chlamydia

Answer 3

Always treat both as it is a common co-infection

1. ceftriaxone for gonorrhea (can use cipro)
2. Azithromycin for chlamydia

Question 4

What antibiotics are safe in pregnancy

Answer 4

Penicillin
Cephalosporins
aztreonam
Erythromycin
Azythromycin

Question 5

What is the treatment for syphilis

Answer 5

2.4 million units IM of Penicillin G benazathine

Question 6

What is the treatment for syphilis in the penicillin allergic patient

Answer 6

Doxycycline 100mg PO q12hrs x 14 days

For pregnancy or tertiary syphilis the only treatment is penicillin desensitization

Question 7

What is the treatment for a Jarisch-Herxheimer reaction

Answer 7

aspirin and continue treatment against syphilis

Question 8

What test should be run for suspected syphilis if an RPR or VDRL is negative

Answer 8

Darkfield microscopy

25% of RPR and VDRL are negative

Question 9

What symptoms are present with cystitis

Answer 9

Dysuria
WBC in Urine
Suprapubic tenderness

Question 10

What symptoms are present with pyelonephritis

Answer 10

Dysuria
WBC in Urine
Flank pain
Fever

Question 11

What should be considered when a pyelonephritis does not respond to treatment

Answer 11

Perinephric abscess

Question 12

How is endocarditis diagnosed clinically

Answer 12

Presence of:

• 2 Major criteria or,
• 1 Major and 3 minor criteria or,
• 5 minor criteria

Question 13

What are the major Criteria associated with Dukes classification of Infective Endocarditis

Answer 13

2) Abnormal Echocardiagram
- Intracardiac mass
- abcess
- partial dehiscence of prosthetic valve

Question 14

What are the minor Criteria associated with Dukes classification of Infective Endocarditis

Answer 14

1. Fever > 38c
2. Presence of risk factors
3. Vascular findings
4. Immunological findings
5. Microbiological findings insufficient for a major criteria

Question 15

What are the vascular findings associated with infective endocarditis

Answer 15

1. Janeway lesions (flat and painless in hands and feet)
2. Septic pulmonary infarct
3. arterial emboli
4. mycotic aneurism
5. Conjonctival Hemorhage

Question 16

What are the immunological findings associated with Infective Endocarditis

Answer 16

1. Roth Spots (Retina)
2. Osler Nodes (raised, painful, pea shaped)
3. glomerular nephritis

Question 17

When should therapy for HIV be started

Answer 17

1. CD4 < 500
2. Symptomatic patients
3. Pregnant Women
4. Needle stick by known HIV positive pt

Question 18

What is the recommended therapy for starting a patient with HIV

Answer 18

HAART (one of the following combinations)

1. Tenofovir + entricitabine + efavirenz (single pill combination)
2. Zidovudine + lamuvudine + efavirenze
3. Zidovudine + lamuvudine + ritonavir/lopinavir

*** Never use AZT (zidovudine) as a mono therapy

Question 19

What are the adverse effects of NRTI class

Answer 19

lactic acidosis

Question 20

What are the adverse effects of Protease Inhibitors

Answer 20

hyperglycemia

hyperlipidemia

Question 21

What are the adverse effects of NNRTI class

Answer 21

drowsiness

Question 22

What are the adverse effects of zidovudine

Answer 22

anemia

Question 23

What are the adverse effects of didanosine

Answer 23

pancreatitis

neuropathy

Question 24

What are the adverse effects of stavudine

Answer 24

pancreatitis

neuropathy

Question 25

What are the adverse effects of abacavir

Answer 25

rash

Question 26

What are the adverse effects of indinavir

Answer 26

kidney stones

Question 27

Name the NRTI's

Answer 27

``` zidovudine didanosine stavudine lamivudine abacavir emtricitabine tenofovir ```

Question 28

Name the Protease Inhibitors

Answer 28

``` Indinavir ritonavir lopinavir Nelfinavir Saquinavir Darunavir Tipranavir Amprenavir Atazanavir ```

Question 29

Name the NNRTI's

Answer 29

Efavirenz Nevirapine Etravirine Rilpivirine

Question 30

What is the treatment for post exposure prophylaxis to to HIV

Answer 30

HAART for one month

Question 31

If a pt is diagnosed as HIV positive during the routine pregnancy and is not currently on treatment what options are available

Answer 31

1. CD4 < 500: start HAART | 2. CD4 > 500 and low viral load: HAART immediately is better than waiting to 2nd or 3rd trimester

Question 32

When should prophylaxis be initiated for HIV positive patients

Answer 32

CD4 < 200: TMP/SMX against Pneumocystis Jiroveci Pneumonia CD4 <50: Azithromycin once a week against Myconacterium avium Intracellular

Question 33

How will an HIV + patient present when infected with PCP

Answer 33

Shortness of breath Dry cough Hypoxia Increased LDH

Question 34

How is PCP diagnosed

Answer 34

Bronchoalvolar lavage CXR will demonstrate increased interstitial markings bilaterally

Question 35

What should be considered in an HIV patient with nausea, vomiting, headache and focal neurological deficits?

Answer 35

Toxoplasmosis PML (progressive multifocal leukoencepholapathy) Contrast head CT will show Ring enhancing lesions in Toxoplasmosis

Question 36

What treatment is needed for an HIV patient with a CD4 count < 50 that presents with blurry vision?

Answer 36

Patient requires dilated opthomalogic evaluation If treatment is needed for CMV use valgancyclovir

Question 37

If an HIV patient presents to the ER with fever, headache and stiff neck what is the next course of action

Answer 37

Lumbar puncture. - India Ink initially (60% sensitive) - Cryptococcal Antigen test (95% sensitive) If positive treat with Amphotericin B followed by fluconazole

Question 38

What are the opportunistic infections associated with HIV

Answer 38

CD4 < 300: Candidal Esophogitis CD4 < 200: (PCP) Pneumocystis Jiroveci Pneumonia CD4 <50: CMV, Mycobacterium avium Intracellular